By Maya Misikir and
Stephanie Nolen/ NY Times
Climate change, civil conflict and growing resistance to insecticides and treatments are all contributing to an alarming spread of cases.
Maya Misikir reported from Addis Ababa, Ethiopia. Stephanie Nolen covers the global threat of infectious diseases including malaria.
Updated Oct. 26, 2024
Malaria infection rates are soaring in Ethiopia, where a combination of armed conflict, climate change and mosquitoes’ growing resistance to drugs and insecticides has accelerated the spread of a disease the country once thought it was bringing under control.
More than 6.1 million malaria cases, and 1,038 deaths, have been recorded in the country this year through the end of September, compared with 4.5 million cases, and 469 deaths, for all of 2023. Worse, cases are likely to soar far higher in the next couple of months because peak malaria season, driven by seasonal rains, begins in September and runs through the end of the year.
“We’re backsliding so fast — we’ve gone back a decade,” said Fitsum Tadesse, the lead scientist overseeing the malaria program at the Armauer Hansen Research Institute in Addis Ababa, the capital of the country.
The malaria surge in Ethiopia could prove to be a harbinger for other countries in the region, where the same underlying biological factors exist, and war and climate change are making more people vulnerable.
Dr. Tadesse believes some of the rise in cases in Ethiopia may be due to growing drug resistance: The parasites that cause malaria in East Africa are increasingly resistant to treatments that have long been the bedrock of the response.
At the same time, mosquitoes are becoming more resistant to the insecticides that are used on protective bed nets and in indoor spraying programs. And they have evolved to evade diagnosis by some of the most common malaria tests.
“All of the biological factors are converging here, and it’s happening at the worst possible time,” Dr. Tadesse said.
The largest surge in cases has been reported in the country’s Oromia region, where the federal government has been fighting separatist militias in a long-running civil war. The conflict between the Ethiopian armed forces and the Oromo Liberation Army has intensified over the past five years, displacing more than 1.5 million people. Some areas, such as a region called the West Welega Zone, which has recorded some of the highest numbers of malaria cases in 2024, have been inaccessible to humanitarian and aid organizations for year
That fighting has weakened Ethiopia’s health system, disrupted malaria control activities and displaced people, making it harder, sometimes impossible, for them to seek care. They also become more vulnerable to mosquito bites while living in temporary shelter. And they may take the malaria parasite with them, spreading the disease into new areas. Ethiopia’s borders, including its northwestern boundary with Sudan, which has a massive civil conflict of its own, are porous.
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Humanitarian agencies have been unable to distribute bed nets, medications or diagnostic tests. Without prompt diagnosis and treatment, malaria can move swiftly through families and then whole communities.
Simultaneously, a changing climate has made new parts of Ethiopia vulnerable; towns with no previous history of malaria reported the disease this year. Many outbreaks were reported in highland areas — with elevations above 2,000 meters (about 6,560 feet) — where historically neither the mosquitoes nor the malaria parasite they carry were comfortable. Increasingly, the climate in these areas is becoming warmer and wetter, more hospitable for mosquitoes.
“We still don’t know the intricacies of how climate change is playing a role in all of this, but we do know its impact becomes greater when everything else is disordered,” Dr. Tadesse said.
There is an additional threat in Ethiopia from an invasive Asian mosquito species, called Anopheles stephensi, that has become established in the country in recent years. Malaria has largely been a rural disease in Africa. But stephensi is an urban mosquito, breeding in discarded soda cans and in drainage ditches and thriving in congested cities. It caused a recent surge of malaria cases in the city of Dire Dawa, and has alarmed public health officials whose malaria programs are designed to serve rural areas.
Stephensi also flourishes in building sites, where large open cisterns are used for cement- and brick-making, and such sites are increasingly common in rapidly urbanizing areas.
Seada Ahmed, health education and communication director at the Oromia Health Bureau, said that some urban areas in the region reported their first malaria cases ever this year.
After years of sustained investment mirroring the push against malaria elsewhere in sub-Saharan Africa, the Oromia region saw its cases fall from 900,000 in 2011 to about 100,000 per year in 2019. But last year the number surged to 2.8 million people, and in the last three months alone 1.4 million of 45 million people in the region were diagnosed with malaria.
Some part of that higher case figure reflects better case-finding, Ms. Ahmed said, because community health workers have been going door-to-door to try to detect new infections.
Many of those infections are severe. While just 623 people required hospitalization to treat their symptoms in 2023, more than 41,000 have been admitted to the hospital in the past three months, Ms. Ahmed said.
Ababaye Tilahun has worked for 15 years as a health worker in the West Welega Zone, where the highest case numbers have been recorded.
“We have had malaria in the past, but this year has been exceptionally worse than any other time,” Ms. Tilahun said.
Stephanie Nolen is a global health reporter for The Times.More about Stephanie Nolen
